Provider Demographics
NPI:1609097096
Name:GREEN, ANNETTA M (MA)
Entity type:Individual
Prefix:MS
First Name:ANNETTA
Middle Name:M
Last Name:GREEN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18921 E MERCER DR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80013-3665
Mailing Address - Country:US
Mailing Address - Phone:303-883-3721
Mailing Address - Fax:
Practice Address - Street 1:11059 E BETHANY DRIVE
Practice Address - Street 2:SUITE 200
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014
Practice Address - Country:US
Practice Address - Phone:303-883-3721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health